Oral Rehydration Research Articles

Knowledge, Perceptions and Practices about Oral Rehydration Therapy in Under Five Children Suffering from Diarrhea in Mirpur, AJK

Background: Dehydration associated with diarrheal diseases is a leading cause of mortality. Most of these deaths can be prevented by preventing or timely treating dehydration and using oral rehydration therapy is one of the options. Aim: To evaluate the knowledge and practices associated with the preparation and use of oral rehydration therapy in pediatric patients suffering from diarrhea. Study design: Descriptive cross-sectional study, Place & duration of study: Mohi-ud-Din Teaching Hospital, Mirpur, AJK, from January to August 2021, Methods: Mothers and care-givers of children were selected. A structured questionnaire was used to assess the knowledge and practices of the participants. The information gathered included epidemiological and socio-demographic data as well as about the knowledge, attitude and practices regarding prevention of diarrhea, usage, preparation and mode of administration of oral rehydration therapy among study respondents. Result: Mean age of care givers was 31.53±5.973 years. Mean income of a household was 28233±10986 PKR while median income was 30000 PKR. As per the employment status, 78.33% were housewives and 21.67% of women were working. Regarding the educational status, 15.67% were illiterate while 84.33% were literate. About 46.66% of the participants knew about the various ways to prevent diarrhea. Regarding the knowledge and assessment of practices of care givers about home-based remedies and ORT, majority of the participants, 78.33%, knew about ORT, 75% have used ORT and 69.33% knew about how to prepare ORT. Furthermore, 64.66% prepared ORT using standard method and 65% knew that ORT replaced lost water in the body. Conclusion: There was a high level of information and awareness among caregivers about the oral rehydration therapy, its correct preparation, usage and method of administration leading to its appropriate usage in diarrhea patients. But still there is a need to increase the awareness among people by mass awareness campaigns to better inform the masses and to maximize the acceptability, usage and benefits of oral rehydration therapy. Keywords: Dehydration, diarrhea, rehydration, therapy, oral

Literature Review: The Effect of Honey for Children with Diarrhea

Diarrhea is an endemic disease that has the potential to cause Extraordinary Events (Kejadian Luar Biasa/KLB) and is still a contributor to mortality in Indonesia, especially in toddlers. The common management of diarrhea is using oral rehydration therapy (ORS) to prevent dehydration. Moreover, honey could be useful also in handling diarrhea since it has anti-bacterial elements in it. The purpose of this study was to determine the effect of giving honey in children with diarrhea. The method used was literature review. There were 9 research articles obtained, and they revealed that there is an effect of giving honey to children who have diarrhea. This effect was proven by a greater decrease in the degree of dehydration in children who were given honey and standard therapy, the frequency of bowel movements in children who were given honey, as well as the stool consistency which was getting better. Healing time for children with diarrhea who were given honey and standard therapy was faster than children who only received standard therapy.

Growth Charts on Postage Stamps

Growth charts are among the tools used by nutritionists to track infant and child well-being. Numerous countries have depicted growth charts on their postage stamps, along with other GOBI components of child health (oral rehydration, breastfeeding, and immunizations). Postage stamps are useful in conveying essential health information to the populace and they honor worldwide efforts to improve child health. This article presents examples of GOBI depictions on postage stamps around the world, with special focus on growth charts.

Assessment of Maternal Knowledge and Practices Regarding Acute Diarrheal Illnesses in Children in Saudi Arabia: A Tertiary Care Center Survey.

Background Diarrheal illness remains one of the most common causes of death among children specifically those who live in developing countries. Appropriate mothers' knowledge and practice regarding acute diarrhea illness in children can considerably reduce diarrhea-related morbidity and mortality. So, the aim of this study was to evaluate mothers' knowledge and practice regarding acute diarrheal illness in children. Method This cross-sectional study was conducted in a tertiary hospital in Riyadh, Saudi Arabia using a newly developed questionnaire that was distributed to King Abdullah Specialist Children. The calculated sample size was 375. Results A total of 375 mothers were included in this study and the majority of them(99%) were Saudis. More than half of the participants (61%) were university graduates.The majority(96.5%) choseprevious experience as the main source of information about diarrhea while(40%) chose physician. Most of the mothers(69.6%) believed that teething is the leading cause of diarrheal illness in children. Regarding the treatment, fluid was recognized to be the major treatmentfor diarrhea as chosen by the mothers. Around (42.7%) of the respondents thought intravenous fluid is more effective than oral rehydration solution (ORS) in treating dehydration associated withdiarrheal episodes. ORS was the main type of fluid (74.1%) which was selected by the mothers to be given during the diarrheal episode. Conclusion Mothers showed good knowledge and practice overall in regard to acute diarrheal illness in children. However, this study revealed some misconceptions among the caregivers which necessitates more educational sessions to be conducted in the community and during the hospital visit.

COMPARISON OF RACECADOTRIL WITH ORAL REHYDRATION SOLUTION IN ACUTE WATERY DIARRHEA UNDER 5 YEARS OF AGE

BACKGROUND: A significant share (18%) of paediatric mortality is caused by diarrheal diseases. Children under the age of five are most susceptible to viral diarrhoea. In cases of acute watery diarrhoea, racecadotril, an anti-secretory medication, can limit fluid and electrolyte loss from the intestine without compromising intestinal motility.
 OBJECTIVE: To compare the number of loose stools within the first 48 hours of admission between the children treated with and without Racecadotril, as well as the mean recovery time in children in both groups, in order to determine the efficacy of Racecadotril in treating acute watery diarrhoea in children aged 6 months to 5 years.
 METHOD: It was a Randomized Controlled Trial that ran from October 2020 to March 2021 at the Paediatrics Department at LGH/PGMI/AMC Lahore. Patients were divided into two equal groups at random using a computer-generated random number table. Racecadotril (1.5 mg/kg body weight, orally three times per day for 5 days or until diarrhoea ceases, whichever happens first) was given to 100 patients in group A coupled with Low Osmolality ORS, while Low Osmolality ORS was given to 100 patients in group B. For testing of blood haemoglobin, blood urea and creatinine, blood sugar, serum electrolytes, and stool (pH, microscopic inspection, culture, and sensitivity), blood samples were sent to a hospital pathology lab. As per operational definition, recovery time was documented.
 RESULTS: In our study, the mean recovery time was 37.88 hours in group A (racecadotril plus low osmolality ORS) and 47.40 hours in group B (low osmolality ORS), demonstrating a substantial reduction in recovery time of 20.08 percent (p value = 0.0026). The mean 48-hour stool frequency was 11.34 episodes in the Racecadotril + low osmolality ORS group and 14.98 episodes in the low osmolality ORS group, demonstrating a statistically significant decrease in stool frequency of 24.29 percent with the Racecadotril group (p value = 0.025). Faster recovery (20.08 percent) and a reduction of 20.52 percent in ORS consumption, which is comparable with earlier trials on Racecadotril conducted in children with acute watery diarrhoea.
 CONCLUSION: In managing children under the age of five who have acute watery diarrhoea, we came to the conclusion that there is a substantial difference in the mean recovery time when Racecadotril and Low Osmolality Oral Rehydration Solution (ORS) are used in combination

Quality evaluation of Oral Rehydration Salt (ORS) products marketed in Abuja, Nigeria

Medicine security remains one of the public health challenges in Sub-Saharan Africa as the report by World Health Organization (WHO) shows that 10.5% of medicines in low and middle-income countries worldwide are falsified or substandard. The study aimed to evaluate the quality of Oral Rehydration Salt (ORS) products sold in pharmacy outlets in Abuja, Nigeria. Seventeen different commercial brands of WHO recommended low-osmolarity ORS finished pharmaceutical products (FPP) were randomly selected from pharmacy outlets in the Federal Capital Territory (FCT) and Gwagwalada Area Council in Abuja. They were assessed for quality based on physicochemical properties and the content of active pharmaceutical ingredients in accordance with the International Pharmacopeia (IP) guidelines. The shelf lives of all the samples were valid, and they all met the visual inspection test, labelling, pH (7.4‒8.0 between23.3‒23.9°C) and moisture content (1‒9 mg/g) requirements. The content assay revealed 88.2%, 88.2%, 64.7%, 47.1%, and 35.3% compliance of the samples for glucose, chloride, citrate, sodium and potassium, respectively. Twelve (76.5%) of the brands failed at least one content assay and 8 (47%) had zero potassium content. The study underscores the need for regular, periodic post-market surveillance on essential medicines sold in the Nigerian market.

The effects of fluid absorption and plasma volume changes in athletes following consumption of various beverages

BackgroundTo verify the hydration effects of oral rehydration solution (ORS) on athletes by comparing the degrees of fluid absorption and plasma volume changes following beverage consumption, including ORS.MethodsThirty-one participants visited the testing laboratory 4 times at 1-week intervals to consume 1 L of beverage (e.g., water, ORS, and two sports drinks [SpD]) for 30 min on each visit. The urine output was measured 4 times at 1 h, 2 h, 3 h, and 4 h after beverage consumption. A blood sample was collected 3 times at 1 h, 2 h, and 3 h after beverage consumption. Body weight was measured once in 4 h after beverage consumption.ResultsBody weight change was smaller for ORS than for water, SpD1, and SpD2 (p < 0.05). Cumulative urine output in 4 h was lower for ORS, SpD1, and SpD2 than for water (p < 0.05), and it was lower for ORS than for SpD2 (p < 0.05). BHI in 4 h was higher for ORS, SpD1, and SpD2 than for water (p < 0.05), and it was higher for ORS than for SpD2 (p < 0.05). There was no significant difference in PVC for different beverages at all test times, i.e.., 1 h, 2 h, and 3 h.ConclusionsWe evaluated the hydration effects of the consumption of beverages, such as water, SpD, and ORS in athletes. ORS and SpD were more effective than water. A comparison between ORS and SpD showed that the result could vary depending on the type of SpD.

Differential Utilisation of two Therapeutic Methods in the Management of Diarrhoea among Under-Five Children Attending Primary Health Care Centres in Oyo State, Nigeria

Diarrhoea remains the leading killer of children, accounting for approximately 9 percent of all deaths among children under age 5 worldwide in 2019. This translates to over 1,300 young children under five dying each day, or about 484,000 children a year, despite the availability of a simple treatment solution like the use of oral rehydration therapy (ORS) and zinc supplements. Therefore, this study evaluated the differential utilisation of ORS and Zinc supplements in the management of diarrhoea among under five children attending primary health care centres in Oyo State, Nigeria from 2017 to 2021. The researcher conducted a retrospective cohort study from 2017 to 2021 to evaluate the differential utilisation of ORS and Zinc supplements in the management of diarrhoea among under five children in Oyo State, Nigeria. Secondary analysis of the treatment data from selected primary health care centres in Oyo State was conducted from 2017 to 2021; the number of patients diagnosed of diarrhoea with their age group and treated with either ORS or zinc supplements on admission were analysed for each year at each of the PHC. A significant positive, near perfect correlation was found to occur between number of diarrhoea cases and ORS usage and age range (r= 0.983; p=0.01) and number of diarrhoea cases with Zinc usage (r= 0.914; p= 0.01); translating to the fact that ORS and Zinc usages increased with increased number of diarrhoea cases. Increase in ORS usage also positively correlates with usage of Zinc among the under five children. It was concluded that the most affected age group with the highest diarrhoea rate are children within 12-59 months. There is thus a need to improve the sensitisation of the use of oral rehydration therapy and zinc supplements by the health care workers in our Primary Health Care centres. Again, adequate preventive and control strategies should be put in place at the PHC, Local and State levels to improve on data reporting on cases of under-five diarrhoea disease.

Single-Strain Probiotics For The Management Of Acute Diarrhea In Children: A Randomized Comparative Study

Goals To assess the efficacy of probiotics in managing acute gastroenteritis in children, including reducing the need for inpatient care and antibiotics, repeat visits to emergency or private clinics, and incidence of adverse events. Background Acute gastroenteritis is characterized by diarrhea, vomiting, and occasionally, abdominal pain and fever. Treatments include oral rehydration solutions to prevent dehydration and nutritional damage and zinc supplementation to reduce the severity of diarrhea and reoccurrence. Probiotics are effective in reducing the intensity and duration of acute gastroenteritis; however, their efficacy in the Indian population needs further investigation. Study In this single-center open-label randomized study, the efficacy of 3 single-strain probiotics, Bacillus clausii, Saccharomyces boulardii, and Lactobacillus rhamnosus GG, as adjuvant therapy along with oral rehydration solution and zinc supplements in the management of acute gastroenteritis, were compared in 150 children aged 6 months to 16 years. Results B. clausii was the most effective single-strain probiotic in our study for the management of acute diarrhea in children across various parameters, including time to first formed stool, reduction in the duration of diarrhea, reduced hospital admissions, and earlier recovery. Conclusions All 3 probiotics demonstrated no adverse effects. Readmission and revisit rates after treatment with these probiotics were extremely low. B. clausii is strongly recommended as adjuvant therapy in children with acute gastroenteritis.

Spectrum of underlying diseases in syncope and treatment of neurally-mediated syncope in children and adolescents over the past 30 years: A single center study.

Syncope is the primary cause of transient loss of consciousness, which causes severe physical and mental burdens to children and adolescents. The study was designed to analyze the spectrum of underlying diseases of syncope and treatment options for neurally-mediated syncope (NMS) in Chinese children and adolescents. Medical records including history, physical examination, blood biochemistry, standing test, head-up tilt (HUTT), sitting-up test, electroencephalogram (EEG), electrocardiogram (ECG), and echocardiography were retrospectively studied in children and adolescents admitted to the National Pediatric Syncope Center, Department of Pediatrics, Peking University First Hospital between 1992 and 2021. All the data were collected from the Beijing Kaihua Medical Management System (Kaihua, Beijing, China). Children who met the syncope diagnostic criteria were enrolled in the study. The spectrum of the underlying diseases of syncope in children and adolescents and the treatment options of NMS were analyzed. A total of 1,947 children and adolescents with syncope were admitted, including 869 males (44.63%) and 1,078 females (55.37%) aged 1-18 years, with an average age of 11.1 ± 3.1 years. The number of children and adolescents with syncope displayed a gradually increasing trend between 1992 and 2021 except after 2020. NMS proportion increased, and the proportion of unexplained syncope decreased (χ2 = 128.839, P < 0.01). The treatment options of NMS mainly included autonomic nervous function exercise (549, 34.46%), oral rehydration salt (ORS; 445, 27.94%), metoprolol (219, 13.75%), midodrine (120, 7.53%), ORS plus metoprolol (139, 8.73%), ORS plus midodrine (120, 7.53%), and pacemakers (1, 0.06%). Patients with vasovagal syncope (VVS) coexisting with postural orthostatic tachycardia syndrome (POTS) were more likely to take pharmacological treatments than those with VVS or POTS only (χ2 = 41.696, P < 0.01). The number of children with syncope displayed an increasing trend before 2020, and the proportion of unexplained syncope decreased. Autonomic nervous function exercise was the most common treatment for children and adolescents with NMS. Children with VVS coexisting with POTS were more likely to receive pharmacological treatments than those with either.

Advantages of pyruvate-based fluids in preclinical shock resuscitation-A narrative review.

This review focuses on the innate beneficial effects of sodium pyruvate-based fluids, including pyruvate in intravenous solutions, oral rehydration solutions, and peritoneal dialysis solutions, on shock resuscitation with various animal models relative to current commercial fluids over the last two decades. Due to its superior pharmacological properties, pyruvate effectively sustains cytosolic glycolytic pathways and mitochondrial oxidative phosphorylation by restoration of redox potentials and reactivation of pyruvate dehydrogenase in hypoxia, even anoxia, and diabetes, reversing the Warburg effect and diabetic glucometabolic aberration. Pyruvate has been demonstrated to protect against multiorgan dysfunction and metabolic disturbance in numerous preclinical studies with various pathogenic injuries. The unique features of pyruvate potential clinical benefits encompass to efficiently correct lethal lactic acidosis via metabolically rapid consumption of intracellular [H+] and robustly protect multiorgan metabolism and function, particularly visceral organs in addition to the heart and brain, significantly prolonging survival in various animal models. Pyruvate protection of red blood cell function and preservation of the partial pressure of arterial oxygen should be highly concerned in further studies. Pyruvate is much advantageous over existing anions such as acetate, bicarbonate, chloride, and lactate in commercial fluids. Pyruvate-based fluids act as a therapeutic agent without causing iatrogenic resuscitation injury in addition to being a volume expander, indicating a potential novel generation of resuscitation fluids, including crystalloids and colloids. Pyruvate-based fluids have an enormous potential appeal for clinicians who face the ongoing fluid debate to readily select as the first resuscitation fluid. Clinical trials with pyruvate-based fluids in shock resuscitation are urgently warranted.

Assessment of Knowledge and Usage of Oral Rehydration Therapy in Management of Childhood Diarrhea among Mothers of Kambaza town, Kebbi State, Nigeria

Diarrhea is one of the major causes of infant and young children morbidity and mortality globally. It is characterized by passing of more than 3 watery stools within 24hr which is accompanied by loss of body fluids and electrolytes leading dehydration and death if not treated. Therefore, this study was aimed in assessing knowledge and use of Oral Rehydration Therapy (ORT) in the management of childhood diarrhea among mothers. A cross sectional descriptive study was conducted among 103 mothers living in Kambaza metropolis using a questionnaire for quantitative data collection. The data were analyzed using Statistical Package for Social Sciences (SPSS), version 20 and p-value &lt;0.05 was considered statistically significant. The results showed that a significant proportion of respondents were below the age of 36 years (25-35years) with the mean age of 30±0.327 years and most of them (92.2%) were married. 81.6% of the respondents heard knowledge about ORT and majority of them (82.5%) indicated they know to prepare ORS/SSS. The use of ORT in the management of childhood diarrhea was also found to be high (82.5%) among the mothers. A significant portion of the mothers (95.1%) indicated already made ORS sachet was more effective in treating diarrhea than home-made SSS. There is no significant relationship between maternal level education and use of ORT in the management child diarrhea (p=0.476). However, a significant relationship exit between maternal knowledge on ORT preparation and its usage for management of childhood diarrhea (p=0.037). This study recorded high knowledge and use of ORT for management of childhood diarrhea among mothers of under-five children. Therefore, it recommended that maternal knowledge on use of ORT and its preparation should be encourage.

The magnitude of oral rehydration salt utilization in diarrhea hot spot regions of Ethiopia and its associated factors among under-five children: A multilevel analysis based on Bayesian approach.

Diarrhea leads the children to severe dehydration or death as a result of the loss of water and electrolytes (namely, potassium, chloride, sodium, and bicarbonate). To compensate for the losses, ORS is given to children who experienced diarrhea. To estimate the magnitude of ORS utilization in diarrhea hotspot regions of Ethiopia and to assess its associated factors among under-five children. To conduct this study, we used the 2016 Ethiopian demographic and health survey data. A total of 1,079 weighted sample children were selected. Each sample was selected randomly. Then, to identify factors associated with ORS utilization in diarrhea hotspot regions of Ethiopia, a multilevel analysis based on the Bayesian approach was applied. Finally, the credible interval of AOR that does not include 1 was considered statistically significant. The magnitude of ORS utilization for children in diarrhea hotspot regions of Ethiopia was 28%. Being urban resident (AOR = 1.92; 95% CrI: 1.13-3.3), woman household head (AOR = 2.11; 95% CrI: 1.3-3.9), having higher educational level (AOR = 1.52; 95% CrI: 1.04-2.22), member of health insurance (AOR = 1.73; 95% CrI: 1.14-2.43), and being exposed for media (AOR = 1.43; 95% CrI: 1.18-2.5) increases ORS utilization for diarrhea management. Residence, educational level, health insurance, and media exposure were the factors of ORS utilization. So, to increase the practice of ORS utilization for diarrhea management in Ethiopia, the Ministry of Health and the Government of Ethiopia should consider those factors when they design diarrhea prevention and control strategies.

Childhood Diarrhea Prevalence and Uptake of Oral Rehydration Solution and Zinc Treatment in Nigeria.

Given the disproportionate burden of childhood diarrhea deaths in Nigeria, this study assessed the prevalence and predictors of the disease and the uptake of ORS and zinc supplementation as treatments in a population-based national survey. Cross-sectional data from the 2018 Nigeria Demographic Health Survey were used. A log-Poisson regression was used to estimate the relative risks (RR) for the individual-level predictors of childhood diarrhea and the uptake of ORS and zinc treatments. A total of 30,713 children under 5 years of age were included in the survey. The period prevalence of reported diarrhea in the last two weeks was 12.9% (95% CI: 12.5%, 13.3%). Among the children with diarrhea, the proportion who received ORS was 39.7% (95% CI:38.2%, 41.3%), while 29.1% of them received zinc supplements (95% CI:27.7%, 30.5%), and 21.8% of them received both the ORS and zinc treatments as recommended. Children under 6 months of age with diarrhea had a significantly lower likelihood of being given ORS or zinc when they were compared to the older children. The institutional delivery of them, maternal employment, and improved water sources were also independent predictors of the uptake of ORS and zinc treatments for diarrhea (p-values &lt; 0.05). Interventions to prevent childhood diarrhea and improve the coverage of ORS and zinc treatments may reduce the large burden of childhood diarrhea deaths in Nigeria.

Knowledge of ORS packet or pre-packaged liquids and its determinants for the management of diarrhea among women of reproductive age: multilevel analysis of 32 sub-Saharan African countries demographic and health survey

BackgroundInfant and child mortality due to diarrhea is a very serious and widespread problem all over the world, particularly in sub-Saharan African countries. Using an oral rehydration solution (ORS) is an easy, inexpensive, and reliable way of treating dehydration and reducing diarrhea-related mortalities. However, there is limited evidence on the magnitude of knowledge of ORS packets or pre-packaged liquids and determinant factors among women in sub-Saharan African countries. Hence, This study sought to assess knowledge of ORS packets or pre-packaged liquids and determinant factors for the management of diarrhea among women of reproductive age in 32 sub-Saharan African countries.MethodData for the study were drawn from a recent 32 demographic and health surveys (DHS) conducted in sub-Saharan African countries. A total sample of 234,848 mothers who gave birth in the last 5 years preceding the survey was included. STATA version 16 was used to clean and analyze the data. Multilevel multivariable logistic regression was employed to identify factors associated with knowledge of ORS packets or pre-packaged liquids in sub-Saharan African countries. In the multivariable analysis, an adjusted odd ratio with a 95% confidence level was reported to indicate statistical association with a P value < 0.05.ResultsThe overall magnitude of knowledge of ORS packets or pre-packaged liquids in sub-Saharan African countries were 80.59% (95% CI: 80.42%, 80.74%). Individual-level factors such as women who were aged 25 -39, (AOR = 1.30; 95%CI; 1.27, 1.34) and aged > 35 (AOR = 1.44; 95%CI; 1.40,1.49),women having primary education (AOR = 1.51; 95%CI; 1.47, 1.56), secondary and above education (AOR = 1.80; 95%CI; 1.74, 1.86), women who were working (AOR = 1.38; 95%CI; 1.35, 1.42), household size of 6–10, & > 10, (AOR = 1.08; 95%CI; 1.05, 1.10) and (AOR = 1.10; 95%CI; 1.06, 1.14), women from middle and rich household (AOR = 1.09 95%CI; 1.06, 1.12) and (AOR = 1.51 95%CI; 1.47, 1.56), media exposure (AOR = 1.20 95%CI; 1.17, 1.23), ANC visit (AOR = 2.11 95%CI; 2.04, 2.17), living in regions of East Africa, West Africa and Southern Africa have 2.45 (AOR = 2.45 95%CI; 2.36, 2.53), 2.21 (AOR = 2.21 95%CI; 2.14, 2.27), 1.95 (AOR = 1.95 95%CI; 1.83, 2.08) were significantly associated with womens knowledge about ORS packet or pre-packaged liquids.ConclusionOne in five women does not know ORS packets or pre-packaged liquids. Maternal age, women’s education, working status, household wealth index, household size Media exposure, ANC visit, and region were significant predictors of knowledge of ORS packets or pre-packaged liquids. Therefore, it is better to give special emphasis to young age, women who had no formal education and who have no media exposure, poor households, those women who have not currently working as well as those who have a household size of greater than six. Furthermore, it is critical to increase ANC visits to improve knowledge of ORS packets or pre-packaged liquids.

PSAT214 Management of Hyperparathyroidism Associated with Severe Hypercalcemia Presenting During Labour

Abstract Background Hypercalcemia is a rare pathology in pregnancy, and primary hyperparathyroidism (PHPT) has been described as the most common cause. No guidelines exist concerning treatment of PHPT during pregnancy, although most authors favor surgery as the treatment of choice during the second trimester. Nonetheless, management during the third trimester of pregnancy is challenging due to lack of current guidelines. Clinical case This 29-year pregnant female presenting at 38-weeks gestation with spontaneous rupture of membranes and admitted for latent labor. She was incidentally found to have hypercalcemia. Endocrinology was consulted for asymptomatic hypercalcemia in the third trimester of pregnancy. A diagnosis of primary hyperparathyroidism (PHPT) was suspected based on elevated serum calcium adjusted for albumin (16 mg/dL, normal range 8.5-10.5 mg/dL) and elevated PTH levels (121 pg/mL, normal range 14-65 pg/mL). In addition, parathyroid hormone related peptide (PTHrP) was less than 2.0 pmol/L (normal range &amp;lt;2.0 pmol/L), 25-hydroxy vitamin D was 35.6 ng/mL (normal range 30-50 ng/mL) and urine calcium/creatinine clearance ratio (CCCR) level was 0.02 (&amp;lt;0.01 familial hypocalciuric hypercalcemia is likely, &amp;gt;0.02 PHPT is likely) further supporting the diagnosis of PHPT. No parathyroid imaging was performed as there was no plan for surgical intervention at that time. Conservative management was initiated with aggressive oral and intravenous fluid rehydration. The patient subsequently had an uneventful vaginal delivery with the arrival of a healthy newborn eight hours after treatment was initiated. With continued IV and oral hydration, corrected calcium fell by a total of 5 mg/dL. Given an uneventful postpartum course as well as improving calcium levels with hydration, the patient was discharged on day three of hospitalization with a plan for outpatient endocrinology follow up in preparation for future parathyroidectomy. Conclusion There is no previous case report describing severe hypercalcemia in the third trimester of pregnancy managed conservatively solely with hydration. Calcitonin has been attempted but use is limited secondary to tachyphylaxis. Additionally, some case reports suggest cinacalcet use but this drug crosses the placenta. In this unique and complicated case of severe hypercalcemia diagnosed in the third trimester of pregnancy, conservative management with intensive oral and intravenous fluid rehydration was safe and effective in lowering serum calcium levels and therefore conducive to a positive pregnancy outcome. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Congenital chloride diarrhea presenting as dilated fetal bowel loops.

Congenital chloride diarrhea presenting as dilated fetal bowel loops.

Development and Implementation of an Enterally Based Resuscitation Bundle for Major Burn Injury in an Austere Setting: Early Findings from a Pilot Hybrid II Effectiveness-Implementation Randomized Trial

INTRODUCTION: Resuscitation for major burn is challenging globally, from low- and middle-income countries (LMICs) to military and mass casualty settings. Enterally based resuscitation (ER) may have operational advantages in austere settings. However, there are no data to inform ER implementation in real-world scenarios. We describe the early implementation of an ER bundle in an austere environment. METHODS: This single-center pilot effectiveness-implementation randomized trial in Nepal aims to enroll 30 adult patients with 20% to 40% total body surface area (TBSA) burns. Intervention arm receives goal-directed ER with oral rehydration solution administered orally or via nasogastric lavage. Standard of care arm is goal-directed IV resuscitation. Both arms received education, supplies, flowsheets, and communication tool. Resuscitation endpoints, symptoms, biomarkers, and clinical outcomes are measured. The Consolidated Framework for Implementation Research is being used to identify challenges and facilitators of ER implementation via provider focus group discussions (FGD), patient in-depth interviews, and quantitative measures of protocol fidelity. The first 12 patients are presented. RESULTS: Pre-enrollment FGD informed development of context-appropriate ER and IV protocols and implementation strategies. The first 12 patients were allocated equally across arms. One patient crossed over from ER owing to gastrointestinal (GI) intolerance, although GI symptoms were similar in both groups (4 IV vs 3 ER). Twenty-four-hour resuscitation volumes, urine, output and serum creatinine are similar across both groups (Table). Table. - Patient Demographics and IV and Enterally Based Measures Demographic IV resuscitation (n=6) Enterally based resuscitation (n=6) Patient age, median 45.5 years (IQR 27.5-53.8) 30.5 years (IQR 23.8-51.5) Burn size, median (% TBSA) 32% (IQR 30-39) 24% (IQR 22-29) Time to presentation, median 13.75 hours (IQR 13.0-15.6) 6.25 hours (IQR 2.9-11.1) 24-hour urine output, median 1.06 mL/kg/hr (IQR 0.75-1.10) 0.88 mL/kg/hr (IQR 0.85-0.88) 24-hour resuscitation volume, median 3.85 mL/kg/%TBSA (IQR 3.53-4.67) 5.81 mL/kg/%TBSA (IQR 4.45-8.42) Arterial lactate at 24 hours, median 1.10 mmol/L (IQR 1.00-1.28) 2.05 mmol/L (IQR 1.85-2.40) Serum creatinine at 72 hours, median 0.69 mg/dL (IQR 0.62-0.72) 0.61 mg/dL (IQR 0.55-0.7) GI symptoms* during resuscitation 4 3 *GI symptoms are considered any of the following: nausea, bloating, distension, diarrhea, vomiting. CONCLUSION: An ER protocol was successfully implemented in an austere environment. Resuscitation endpoints are currently similar between both arms, indicating that ER is likely effective in austere environments.

Prevalence and predictors of oral rehydration therapy, zinc, and other treatments for diarrhoea among children under-five in sub-Saharan Africa.

BackgroundDespite the evidence-based effectiveness of diarrhoea treatment in preventing diarrhoea-related child mortality, the accessibility and utilization of diarrhoea treatments remain low in sub-Saharan Africa, even though these treatments are available. Therefore, this study aimed to assess the prevalence and predictors of diarrhoea treatment among under-five children in sub-Saharan Africa.MethodsThis study involved cross-sectional analyses of secondary data from the most recent Demographic and Health Surveys of 30 countries in sub-Saharan Africa. Percentages with their respective 95% confidence intervals (CI) were used to summarise the prevalence of diarrhoea treatment. A multivariable multilevel binary logistic regression analysis was employed to examine the predictors of diarrhoea treatment among children under five years in sub-Saharan Africa. The regression results were presented using adjusted odds ratio with their accompanying 95% confidence intervals. Statistical significance was set at p<0.05. Stata software version 16.0 was used for the analyses.ResultsThe overall prevalence of diarrhoea treatment among under-five children in sub-Saharan Africa was 49.07% (95% CI = 44.50–53.64). The prevalence of diarrhoea treatment ranged from 23.93% (95% CI = 20.92–26.94) in Zimbabwe to 66.32% (95% CI = 61.67–70.97) in Liberia. Children aged 1 to 4 years, those whose mothers had at least primary education, those whose mothers had postnatal care visits, those whose mothers believed that permission to go and get medical help for self was a big problem, and those whose mothers’ partners had at least primary education were more likely to undergo diarrhoea treatment as compared to their counterparts. The odds of diarrhoea treatment increased with increasing wealth index with the highest odds among those in the richest quintile. Also, the odds of diarrhoea treatment was higher in the Central, Eastern, and Western geographical subregions compared to those in the Southern geographical subregion. However, children whose mothers were cohabiting, those whose mothers were exposed to watching television, and those living in female-headed households were less likely to undergo diarrhoea treatment.ConclusionThe study found that the prevalence of diarrhoea treatment among children in sub-Saharan Africa was relatively low and varied across countries. The sub-regional estimates of diarrhoea treatment and identified associated factors can support country-specific needs assessments targeted at improving policy makers’ understanding of within-country disparities in diarrhoea treatment. Planned interventions (e.g., provision of quality and affordable supply of oral rehydration salts and zinc) should seek to scale up diarrhoea treatment uptake among under-five children in sub-Saharan Africa with much focus on the factors identified in this study.

An Assessment of Household Knowledge and Practices during a Cholera Epidemic- Dar es Salaam, Tanzania, 2016.

From August 15, 2015 to March 5, 2016, Tanzania reported 16,521 cholera cases and 251 deaths, with 4,596 cases and 44 deaths in its largest city, Dar es Salaam. To evaluate outbreak response efforts, we conducted a household survey with drinking water testing in the five most affected wards in Dar es Salaam. We interviewed 641 households 6 months after the beginning of the outbreak. Although most respondents knew that cholera causes diarrhea (90%) and would seek care if suspecting cholera (95%), only 45% were aware of the current outbreak in the area and only 5% would use oral rehydration salts (ORS) if ill. Of 200 (31%) respondents reporting no regular water treatment, 46% believed treatment was unnecessary and 18% believed treatment was too expensive. Fecal contamination was found in 45% of water samples and was associated with water availability (P = 0.047). Only 11% of samples had detectable free chlorine residual, which was associated with water availability (P = 0.025), reported current water treatment (P = 0.006), and observed free chlorine product in the household (P = 0.015). The provision of accessible, adequately chlorinated water supply, and implementation of social mobilization campaigns advocating household water treatment and use of ORS should be prioritized to address gaps in cholera prevention and treatment activities.